Needle Navigation Research Articles

Noncontact measurement of puncture needle angle using augmented reality technology in computed tomography-guided biopsy: stereotactic coordinate design and accuracy evaluation.

This study aims to introduce a new handheld device application for noncontact and real-time measurements of the angle of a biopsy needle using augmented reality (AR) image tracking technology. Furthermore, this study discusses the methods used to optimize the related coordinate design for computed tomography (CT)-guided biopsy procedures. An in-house noncontact angle measurement application was developed using AR platform software. This application tracks the position and direction of a printed texture located on the handle of a biopsy needle. The needle direction was factorized into two directions: tilting or rolling. Tilting was defined following the tilting of the CT gantry so that rolling would match the angle measured in CT images. In this study, CT-guided tumor biopsies were performed using a conventional guiding method with a protractor. The true value of needle rolling was measured by CT imaging and was then compared to the rolling measurement provided by the application developed in the current study using a mobile phone. This study enrolled 18 cases of tumor biopsy (five renal tumors, five lung tumors, four retroperitoneal tumors, one soft tissue tumor, one thyroid tumor, one mesentery tumor, and one bone tumor). The measurement accuracy was - 0.2°, which was the average difference between AR and CT, and the measurement precision was 2.0°, which was the standard deviation of the difference between AR and CT measurements. The coefficient of determination (R2) was 0.996. The noncontact needle measurement software using AR technology is sufficiently reliable for use in clinical settings. A real-time display of the needle angle that also shows the direction of the CT gantry is expected to enable a simple biopsy needle navigation.

Evaluation of Two Novel Approaches for Needle Navigation in Sacral Nerve Stimulation

Evaluation of Two Novel Approaches for Needle Navigation in Sacral Nerve Stimulation

Optically Tracked Needle for Ultrasound-Guided Percutaneous Nephrolithotomy Puncture: A Preliminary Report.

Background and Aim: Precise needle puncture of the renal collecting system is an essential step for effective percutaneous nephrolithotomy (PCNL). The use of ultrasound for puncture is receiving increased attention. Ultrasound has recognized limitations related to poor observation of the needle tip. We aimed to assess whether an affordable open-source computerized needle navigation training system, using optically tracked ultrasonography, could improve performance of simulated PCNL puncture by urologic trainees, compared with conventional free hand manual sonographic puncture. Materials and Methods: This study describes a PCNL navigation system that can be recreated with any standard ultrasound machine using relatively inexpensive components. The system allows the needle tip to be precisely appreciated in the ultrasound image, its trajectory planned, and the appreciation of needle tip to target calix proximity sound effect. Eight participants (six trainees and two qualified urologists) assessed the PCNL training model. Alternating starting with freehand (control) and tracked needle (experimental) punctures were performed on a phantom kidney. Total procedure and the number of reinsertions required were recorded. Results: The mean time for freehand puncture was 89 seconds (range 13-173), whereas that of the optically tracked needle was 36 seconds (range 12-72). Thus, puncture time was significantly reduced by an average of 53 seconds (p = 0.045) in the experimental arm. The mean number of needle reinsertions was 3.3 with freehand compared with 1.3 in the optically tracked puncture (p = 0.005). The mean square root error of the optical tracking system was 1.8 mm (four calibrations averaged). Conclusion: This study demonstrates that affordable hardware and open-source software can be used to construct an optically tracked ultrasound navigation system for PCNL training. Statistically significant reduced puncture time and number of passes required for effective puncture are demonstrated. We feel that computerized needle tracking during PCNL puncture deserves further evaluation in a training and, potentially, in a clinical setting.

On the flexible needle insertion into the human liver

In the present research, the navigation of a flexible needle into the human liver in the context of the robotic-assisted intraoperative treatment of the liver tumors, is reported. Cosserat (micropolar) elasticity is applied to describe the interaction between the needle and the human liver. The theory incorporates the local rotation of points and the couple stress (a torque per unit area) as well as the force stress (force per unit area) representing the chiral features of the human liver. To predict the deformation of the needle and the liver, the elastic properties of the human liver have been evaluated. Outcomes reveal that considering smaller deformations of the needle and the liver results in better needle navigation mechanism. The needle geometry can enhance the penetration.

Treatment of hepatocellular carcinoma using the Smart Fusion needle navigation system: conversion from real-time 4D-echo data

Advances in ultrasound systems have improved the accuracy of hepatocellular carcinoma (HCC) diagnosis and treatment. We have been treating HCC using real-time 4D and Live 3D-echo technologies. However, these treatment methods have drawbacks such as vibrations during puncture and a limited angle of needle insertion. To overcome these problems, systems that can display ultrasound images simultaneously with computed tomography (CT) and magnetic resonance images in a real-time manner for reference purposes have been reported. These systems have recently been equipped with a needle tip navigation system, making it possible to reliably visualize tumors and determine the needle tip position in a tumor. These developments have enabled the safe treatment of HCC. Treatment using needle navigation is performed as follows: A Canon APLIO800 ultrasound system is used with a conventional convex probe (PVT-375BT) and a micro-convex probe (PVT-382BT). The system function is known as Smart Fusion. Ultrasound images can be displayed with volume data from other modalities, such as CT and magnetic resonance imaging (MRI), in relation to the positional information using a magnetic sensor. This enables the use of CT/MRI data as reference for accurate puncture and treatment of lesions that are difficult to identify by ultrasound alone. Axis alignment is also completed by displaying the xiphoid process on a CT image and having the system learn the orientation of the probe placed perpendicular to the body axis. Then, landmark alignment is performed and fine-adjusted by aligning a target point near the lesion with the same point as displayed on CT (Fig. 1). Case presentation A 7x-year-old woman was found to have elevated tumor markers and a liver tumor identified by regular blood testing and CT performed in August 20xx and was admitted to our hospital for treatment. Abdominal ultrasonography showed a hypoechoic lesion measuring approximately 3 cm in diameter in liver S6, which led to a diagnosis of HCC. For treatment, microwave therapy was selected at the patient’s request. Microwaves were delivered using a Medtronic Emprint ablation system with a 3.0-cm needle for ablation. During treatment, the needle position was confirmed by needle navigation before ablation (Fig. 2) because the tumor needed to be ablated in an overlapping manner (Fig. 3).

3D-printed template and optical needle navigation in CT-guided iodine-125 permanent seed implantation.

PurposeTo preliminarily verify the accuracy of navigation-assisted seed implantation by comparing pre-operative and actual differences in puncture characteristics and dosimetry in computed tomography (CT)-guided, navigation-assisted radioactive iodine-125 seed implantation, using 3D-printed templates for malignant tumors’ treatment.Material and methodsA total of 27 tumor patients, who were treated with seed implantation under combination guidance in our hospital between December 2019 and December 2020 were enrolled in this study. Navigation needles (n = 1-3) were placed in each patient to obtain pre-operative and intra-operative puncture information, such as angle, depth, insertion point, and tip position. Moreover, dosimetry parameters in pre-operative and post-operative plans, including D90, V100, V150, V200, minimum peripheral dose (MPD), conformal index, external index, and homogeneity index of target area were investigated.ResultsMean errors of the angle, depth, insertion point, and tip position were 0.5 ±0.5°, 4.0 ±2.0 mm, 1.7 ±1 mm, and 3.1 ±1.8 mm, respectively. There were no significant differences between intra-operative and pre-operative angles (p = 0.271), but there was a significant difference in the depth (p = 0.002). Errors of the angle, depth, and insertion point were larger for the pelvic/retroperitoneal area than for the head and neck/chest wall (p < 0.05). With the exception of MPD, there was no significant difference in dosimetry indices between post-operative and preoperative plans (p > 0.05).ConclusionsSeed implantation under combination guidance showed good accuracy, and the actual intra-operative puncture information and post-operative doses were in agreement with those in the pre-operative plan, thereby demonstrating promising prospects for further development.

Comparison of Augmented Reality Display Techniques to Support Medical Needle Insertion.

Augmented reality (AR) may be a useful technique to overcome issues of conventionally used navigation systems supporting medical needle insertions, like increased mental workload and complicated hand-eye coordination. Previous research primarily focused on the development of AR navigation systems designed for specific displaying devices, but differences between employed methods have not been investigated before. To this end, a user study involving a needle insertion task was conducted comparing different AR display techniques with a monitor-based approach as baseline condition for the visualization of navigation information. A video see-through stationary display, an optical see-through head-mounted display and a spatial AR projector-camera-system were investigated in this comparison. Results suggest advantages of using projected navigation information in terms of lower task completion time, lower angular deviation and affirmative subjective participant feedback. Techniques requiring the intermediate view on screens, i.e. the stationary display and the baseline condition, showed less favorable results. Thus, benefits of providing AR navigation information compared to a conventionally used method could be identified. Significant objective measures results, as well as an identification of advantages and disadvantages of individual display techniques contribute to the development and design of improved needle navigation systems.

Electromagnetic (EM) catheter path tracking in ultrasound-guided brachytherapy of the breast.

To evaluate a novel navigation system for breast brachytherapy, based on ultrasound (US)-guided catheter needle implantations followed by electromagnetic (EM) tracking of catheter paths. Breast phantoms were produced, containing US-visible tumors. Ultrasound was used to localize the tumor pose and volume within the phantom, followed by planning an optimal catheter pattern through the tumor using navigation software. An electromagnetic (EM)-tracked catheter needle was used to insert the catheters in the desired pattern. The inserted catheters were visualized on a post-implant CT, serving as ground truth. Electromagnetic (EM) tracking and reconstruction of the inserted catheter paths were performed by pulling a flexible EM guidewire through each catheter, performed in two clinical brachytherapy suites. The accuracy of EM catheter tracking was evaluated by calculating the Hausdorff distance between the EM-tracked and CT-based catheter paths. The accuracy and clinical feasibility of EM catheter tracking were also evaluated in three breast cancer patients, performed in a separate experiment room. A total of 71 catheter needles were implanted into 12 phantoms using US guidance and EM navigation, in an average ± SD time of 8.1 ± 2.9min. The accuracy of EM catheter tracking was dependent on the brachytherapy suite: 2.0 ± 1.2mm in suite 1 and 0.6 ± 0.2mm in suite 2. EM catheter tracking was successfully performed in three breast brachytherapy patients. Catheter tracking typically took less than 5min and had an average accuracy of 1.7 ± 0.3mm. Our preliminary results show a potential role for US guidance and EM needle navigation for implantation of catheters for breast brachytherapy. EM catheter tracking can accurately assess the implant geometry in breast brachytherapy patients. This methodology has the potential to evaluate catheter positions directly after the implantation and during the several fractions of the treatment.

Computer-assisted needle navigation for pediatric internal jugular central venous cannulation: A feasibility study.

Vascular access for central venous catheter placement is technically challenging in children. Ultrasound guidance is recommended for pediatric central venous catheter placement, yet many practitioners rely on imprecise anatomic landmark techniques risking procedure failure due to difficulty mastering ultrasound guidance. A novel navigation system provides a visual overlay on real-time ultrasound images to depict needle trajectory and tip location during cannulation. We report the first pediatric study assessing feasibility and preliminary safety of using a computer-assisted needle navigation system to aid in central venous access. A prospective, institutional review board-approved feasibility study was performed. All participants provided written informed consent. Ten patients (mean age: 11.4 years, five males) underwent central venous catheter placement with ultrasound and navigation system guidance. All procedures were performed by interventional radiologists expert in vascular access. Feasibility was measured through binary (yes/no) responses from participating users assessing device usability and feasibility. The number of needle passes and procedure time measures were also recorded. Internal jugular veins (seven right sided, three left sided) were cannulated in all patients with no complications. Users confirmed navigation system feasibility in all 10 participants. Mean vein diameter and depth was 13.3 × 9.8 ± 3.4 × 2.1 and 7.0 ± 1.7 mm, respectively. Successful cannulation occurred in all patients and required only a single needle pass in 9 of 10 patients. Mean device set-up and vascular access times were 5:31 ± 2:28 and 1:48 ± 2:35 min, respectively. This pilot study suggests that it is feasible to use a novel computer-assisted needle navigation system to safely obtain central venous access under ultrasound guidance in pediatric patients.

Preclinical evaluation of ultrasound-augmented needle navigation for laparoscopic liver ablation.

For laparoscopic ablation to be successful, accurate placement of the needle to the tumor is essential. Laparoscopic ultrasound is an essential tool to guide needle placement, but the ultrasound image is generally presented separately from the laparoscopic image. We aim to evaluate an augmented reality (AR) system which combines laparoscopic ultrasound image, laparoscope video, and the needle trajectory in a unified view. We created a tissue phantom made of gelatin. Artificial tumors represented by plastic spheres were secured in the gelatin at various depths. The top point of the sphere surface was our target, and its 3D coordinates were known. The participants were invited to perform needle placement with and without AR guidance. Once the participant reported that the needle tip had reached the target, the needle tip location was recorded and compared to the ground truth location of the target, and the difference was the target localization error (TLE). The time of the needle placement was also recorded. We further tested the technical feasibility of the AR system in vivo on a 40-kg swine. The AR guidance system was evaluated by two experienced surgeons and two surgical fellows. The users performed needle placement on a total of 26 targets, 13 with AR and 13 without (i.e., the conventional approach). The average TLE for the conventional and the AR approaches was 14.9mm and 11.1mm, respectively. The average needle placement time needed for the conventional and AR approaches was 59.4s and 22.9s, respectively. For the animal study, ultrasound image and needle trajectory were successfully fused with the laparoscopic video in real time and presented on a single screen for the surgeons. By providing projected needle trajectory, we believe our AR system can assist the surgeon with more efficient and precise needle placement.

3:00 PM Abstract No. 156 Computer-assisted needle navigation for pediatric central venous cannulation: a feasibility study

3:00 PM Abstract No. 156 Computer-assisted needle navigation for pediatric central venous cannulation: a feasibility study

Design of a Percutaneous MRI-Guided Needle Robot With Soft Fluid-Driven Actuator

Percutaneous ablation is a standard therapy for most cases of hepatocellular carcinoma (HCC), which is a general type of primary liver cancer. Magnetic resonance imaging (MRI) offers high-contrast images of soft tissue to monitor the ablation procedure. However, the success of MRI-guided ablation still depends on precise intra-tumor probe placement and skin insertion positioning, both of which require highly experienced operators, and can induce inter-operator variability in ablation results. In this letter, we present a semi-automated robotic system for MRI-guided percutaneous needle procedures. The compact and lightweight design enables the direct fixture of robot on the patient body and simultaneous needle targeting at multiple locations with several robots. Accurate (0.89 ± 0.31 mm) needle navigation is achieved by incorporating soft fluid-driven actuators with feedback control and stiffness modulation capabilities. The 3D location of the needle guide is reconfirmed by wireless MR tracking coils. The performance of the robotic platform, such as stiffness, needle positioning accuracy and frequency response was experimentally evaluated. Negligible interference to MR imaging was also validated by an MR compatibility test.

Needle Navigation and Catheter Reconstruction for Breast Brachytherapy Using Open Source Software

Needle Navigation and Catheter Reconstruction for Breast Brachytherapy Using Open Source Software

Ultrasound-guided central venous vascular access-novel needle navigation technology compared with conventional method: A randomized study.

Central venous catheter insertion is a common procedure in the intensive care setting. However, complications persist despite real-time ultrasound guidance. Recent innovation in needle navigation technology using guided positioning system enables the clinician to visualize the needle's real-time position and trajectory as it approaches the target. We hypothesized that the guided positioning system would improve performance time in central venous catheter insertion. A prospective randomized study was conducted in a single-center adult intensive care unit. In total, 100 patients were randomized into two groups. These patients underwent internal jugular vein central venous catheter cannulation with ultrasound guidance (short-axis scan, out-of-plane needling approach) in which one group adopted conventional method, while the other group was aided with the guided positioning system. Outcomes were measured by procedural efficacy (success rate, number of attempts, time to successful cannulation), complications, level of operators' experience, and their satisfaction. All patients had successful cannulation on the first attempt except for one case in the conventional group. The median performance time for the guided positioning system method was longer (25.5 vs 15.5 s; p = 0.01). And 86% of the operators had more than 3-year experience in anesthesia. One post-insertion hematoma occurred in the conventional group. Only 88% of the operators using the guided positioning system method were satisfied compared to 100% in the conventional group. Ultrasound-guided central venous catheter insertion via internal jugular vein was a safe procedure in both conventional and guided positioning system methods. The guided positioning system did not confer additional benefit but was associated with slower performance time and lower satisfaction level among the experienced operators.

Safety and Efficacy of Combined Transarterial Embolization and Percutaneous Radiofrequency Ablation for Liver Tumors Using Cone-Beam CT and Needle Navigation Software in a Single Session

PurposeTo assess the safety and efficacy of single-session transarterial embolization and radiofrequency (RF) ablation for hepatic tumors with the use of needle navigation software. Materials and MethodsRetrospective analysis was conducted of 24 patients with liver cancer undergoing embolization followed by RF ablation between May 2014 and August 2017. Twelve patients each underwent (i) embolization and computed tomography (CT)–guided RF ablation during different sessions (group 1) and (ii) embolization followed by RF ablation with cone-beam CT and Needle Assist software in 1 session (group 2). Median age (70.5 y [range, 58–78 y] vs 70.5 y [range, 50–82 y]; P = .76) and performance status (0/1) were comparable between groups. Median tumor size was significantly larger in group 2 (2 cm [range, 1.0–7.3 cm] vs 3.2 cm [range, 1.1–9.6 cm]; P < .03). Procedure time, effective dose, and number of scans were examined. Efficacy was assessed by modified Response Evaluation Criteria In Solid Tumors after 1 month. Safety was assessed by Society of Interventional Radiology adverse event classification. ResultsGroup 1 had a mean of 8.5 CT scans, vs a mean of 5.0 cone-beam CT scans in group 2 (P < .001). Median procedure times were 110 min in group 1 and 199.5 min in group 2 (P < .001). Median effective doses were 68.8 mSv in group 1 and 55.4 mSv in group 2 (P = .38). There was no difference in complete response between groups (66.7% vs 63.6%; P = 1). ConclusionsTransarterial embolization followed by RF ablation with cone-beam CT and needle guidance software in a single session seems to be safe and effective.

6DOF Needle Pose Estimation for Robot-Assisted Vitreoretinal Surgery

Vitreoretinal (VR) surgery is typical microsurgery with delicate and complex surgical procedures. The vision-based navigation for robot-assisted VR surgery has not been fully exploited because of the challenges that arise from illumination, high precision, and safety assessments. This paper presents a novel method to estimate the 6DOF needle pose specifically for the application of robotic intraocular needle navigation using optical coherence tomography (OCT) volumes. The key ingredients of the proposed method are (1) 3D needle point cloud segmentation in OCT volume and (2) needle point cloud 6DOF pose estimation using a modified iterative closest point (ICP) algorithm. To address the former, a voting mechanism with geometric features of the needle is utilized to robustly segment the needle in OCT volume. Afterward, the CAD model of the needle point cloud is matched with the segmented needle point cloud to estimate the 6DOF needle pose with a proposed shift-rotate ICP (SR-ICP). This method is evaluated by the existing ophthalmic robot on ex-vivo pig eyes. The quantitative and qualitative results are evaluated and presented for the proposed method.

18F-FDG PET/CT-Guided Real-Time Automated Robotic Arm–Assisted Needle Navigation for Percutaneous Biopsy of Hypermetabolic Bone Lesions: Diagnostic Performance and Clinical Impact

The purpose of this study is to establish the feasibility, safety, diagnostic performance, and clinical impact of real-time intraprocedural 18F-FDG PET/CT-guided automated robotic arm-assisted biopsy of hypermetabolic marrow or bone lesions. This prospective study included 73 patients (47 male patients and 26 female patients) who underwent PET/CT-guided biopsy of accessible hypermetabolic marrow or bone lesions. The biopsy needle was inserted into the target lesion with automated robotic arm assistance, and tissue sampling was performed at the site with the highest metabolic activity, after the needle position was confirmed using PET/CT. The results of histopathologic examination and clinical and imaging follow-up examinations were reviewed. The referring physicians were interviewed to assess the clinical impact of interventions on treatment planning. Of the 73 patients assessed, 34 were oncology patients with suspected metastasis or residual disease. The pathologic diagnosis was not known for 38 patients with clinically suspected benign (n = 7) or malignant (n = 31) disease. The remaining patient was suspected of having skeletal sarcoidosis. Thirty-nine marrow lesions and 34 bone lesions were targeted. All procedures were technically successful and safe, and no major complication was observed. Pathologic diagnosis was confirmed for 72 patients, for a diagnostic yield of 98.6%. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for the detection of malignancy (n = 54) were 98.2%, 100%, 100%, 94.7%, and 98.6%, respectively. The procedure was helpful in determining the treatment plan for 91.7% of patients. Automated robotic arm-assisted FDG PET/CT-guided real-time bone biopsy is a feasible and safe intervention with a very high diagnostic yield. It had a major clinical impact on patients with minimal residual FDG uptake on end-of-treatment PET/CT and isolated suspected metastatic lesions.

Concepts for augmented reality visualisation to support needle guidance inside the MRI.

During MRI-guided interventions, navigation support is often separated from the operating field on displays, which impedes the interpretation of positions and orientations of instruments inside the patient's body as well as hand–eye coordination. To overcome these issues projector-based augmented reality can be used to support needle guidance inside the MRI bore directly in the operating field. The authors present two visualisation concepts for needle navigation aids which were compared in an accuracy and usability study with eight participants, four of whom were experienced radiologists. The results show that both concepts are equally accurate (n}{}2.0 pm 0.6 and n}{}1.7 pm 0.5, {rm mm}), useful and easy to use, with clear visual feedback about the state and success of the needle puncture. For easier clinical applicability, a dynamic projection on moving surfaces and organ movement tracking are needed. For now, tests with patients with respiratory arrest are feasible.

A Shallow Angle Short-Axis Out-of-Plane Approach Reduces the Rate of Posterior Wall Injuries in Central Venous Catheterization: A Simulation Study

The short-axis out-of-plane approach (SAX-OOP) is commonly used in ultrasound-guided internal jugular vein catheterization. However, this approach has a risk of posterior vein wall injuries. The authors hypothesized that a shallow angle of approach may reduce the rate of posterior wall injuries compared with the conventional steep angle approach. The present study aimed to evaluate whether a difference in the angle of approach of the needle affects the rate of posterior wall injuries. The present study was a randomized crossover-controlled trial involving 40 medical residents, conducted in the clinical training center at a hospital with a residency program. The primary outcome measure was the rate of posterior vessel wall injuries. Subjects received a didactic lecture during which the instructors taught three SAX-OOP techniques including the conventional free-hand method (procedure C), a needle navigation system (procedure N), and a shallow puncture angle using a guidance system (procedure S). Participants were trained in these approaches under supervision and each technique tested in a simulation environment. Thirty-four of 40 residents had no previous experience with central venous catheterization and were included in the final analysis. The rate of posterior vessel wall injuries in procedure S (9%) was significantly lower than using the other approaches (procedure C, 53%; procedure N, 41%). In conclusion, a shallow angle of approach using the SAX-OOP technique resulted in significantly fewer posterior vein wall injuries in central venous catheterization compared with steep angle techniques.

Projector-based augmented reality system for interventional visualization inside MRI scanners.

Navigation support in interventional magnetic resonance imaging (MRI) is separated from the operating field, which makes it difficult to interpret positions and orientations and to coordinate the necessary hand movements. We developed a projector-based augmented reality system to enable visual navigation of tracked instruments on pre-planned paths and visualization of risk structures directly on the patient inside the MRI bore. To assess the accuracy of the system, a user study was carried out with clinicians in a needle navigation test scenario. The targets were reached with an error of 1.7±0.5mm and the entry points with an error of 1.7±0.8mm. The accuracy results are similar to those reached by live image-guided interventions and related work and confirm that this projective augmented reality prototype for the interventional MRI can serve as a platform for current and future research in augmented reality visualization and dynamic registration.